The day I took the HIV test
In a previous column I called on Department of Health Secretary Enrique Ona to please keep HIV testing confidential and voluntary as mandated in our law.
The column arose from concerns raised by HIV activists that the DOH was considering mandatory testing and case tracing for certain populations at higher risk for infection. The consideration arises from the alarming increase in HIV infections in the Philippines.
In approaching matters of science, my discernment process involves consulting both the experts and the activists. In the case of HIV testing, it was an easy process because the leading infectious disease doctors I consulted were in agreement with the activists. And their reasons are related to both human rights standards and pragmatic concerns based on evidence-based studies.
The experts are saying that the DOH's emphasis on certain populations such as males having sex with males, people who inject drugs, and sex workers is warranted, and falls within the guidelines of expert agencies like UNAIDS. They say this because we have what is called a “concentrated” epidemic. Most infections are coming from particular groups. In concentrated HIV epidemics we can still focus efforts for prevention, treatment care and support for the groups most at risk.
Test me! Test me!
These guidelines however say those who don't belong to the groups at higher risk can still get an HIV infection. That is why in my previous column, I called on everyone 15 to 65 years old to get tested at least once, in line with the US Centers For Disease Control recommendations. I called for this not just because the individual reader may be helped, but also because if everyone – including your mother – voluntarily takes the test, it will help lessen the stigmatization.
Stigmatization is one of the biggest factors for people refusing to get tested, denying their status, refusing to get treatment and practicing safer sexual behaviors. The ongoing stigmatization is one of the biggest reasons testing must remain confidential and voluntary.
In any case, I had myself tested in order to “walk my talk.” I also put on my social scientist hat and decided that I would make myself a case study. In other words I decided to observe everything, including my own reactions. I also decided to enjoy the process thoroughly. I mean, enjoy myself like when I was a child catching bugs to put under my toy microscope. Except this time, I would be the bug.
First, the test was done as part of my yearly physical check up. I did explain to the physician why I wanted the test, not because she wanted an explanation, but because we were having such a pleasant conversation. She is this very competent young woman who immediately started to explain the procedure for me and assure me how easy it would all be.
I learned for example that in that hospital, the request form doesn't even have “HIV” written on it. They use a different name for the test. There is a rather longish form I had to answer and a consent form as well. The doctor then brought me to a nurse who then drew up a bill (a little over a thousand pesos, though I must say that you can get the test for free from the government hospitals) and called for a lab technician to come and do a blood extraction.
It was at this point where the most interesting thing happened. I had decided not to explain myself to the nurses or technicians in order to test their reactions. In truth I felt the need to explain myself though no one was asking for an explanation or showing any judgment. In short, I was self-stigmatizing. What broke my resolve not to explain was when I noticed the price of the test and said, “why, yes, I need to know how much. Oh, it's not that expensive.” Then I looked at the nurses and started blabbing about the Rappler column.
Their responses were polite but non-judgmental. I felt like a fool. Had they seen this before? People explaining themselves needlessly? And what, if ever, were they really thinking? Perhaps they were saying to themselves, “Here we go again, poor thing. As if this mattered. I hope she does not feel she had to lie to us.” In any case I admired their training.
I, on the other hand, was furious with myself. Was I just waiting around for an excuse to explain myself? Was the thought that making myself look like I miser (“Oh the test is so cheap.”) sufficient to break my resolve not to self-stigmatize?And what an elitist excuse to do something detestable!
Having broken my resolve, I gleefully went on to explain myself to the lab technician who did the blood extraction. So I asked whether she was afraid of extracting blood if it would be from someone who could be HIV positive. I got the same polite and reassuring response that I got from the nurses. Except that she did not quite say it, I felt that what was in her mind was, “Of course I don't mind. I am a professional... Duh!”
She assured me this did not enter her mind. She assured me that early on in her studies it was made clear that this was part of the job. She also pointed out that many HIV tests are done routinely for blood donations and for overseas employment applicants when this is required. Like I said, it wasn't she that had problems, it was me.
Doing things right
According to law, no one gets to see my test results except me. Not even my doctor can open the sealed envelope that the results come in. You do get advice and counseling about what any possible result can mean. In our situation for example, people who are not coming from groups at risk have greater chances of having a “false positive” result. This means that your test should actually be negative, but because no technology is perfect, it turns out positive for HIV infection. Counseling should include this possibility and what the next steps should be. For those in higher risks groups, they should be advised that tests need to be repeated even if the test turns out negative. So counseling for members of these groups should include advice about future testing and how to practice safer sex.
On the way home from the hospital, I posted this status on my social media page, “Took an HIV test today.” And, lo! All the responses were wonderful. The majority of people simply signified “like.” I could read their minds, “Ano at naging kulang ka sa pansin? Sige na nga. Like.” (You have become needy for attention? Fine. Like.) Some made comments as if speaking to a child, “Now there's a good girl.”
A few dear ones expressed concern. But as I had now (finally!) taken the moral high ground, I did not choose to “explain” the reasons for the test any further.
My self case-study proves the point of the physicians and activists about keeping the tests voluntary and confidential. If I, a sufficiently well educated person and activist, found myself guilty of self-stigmatization, then certainly the stigma surrounding HIV and the HIV test is still out there. But well-trained staff and well-designed procedures help tremendously. And, if society would be as accepting as my circle of friends, than certainly more people would have themselves tested and, depending on the results, behave accordingly.
My results are back. But I won't share them. These are confidential, you know. The reader is allowed to suspect what he or she wishes to suspect. But, should the reader suspect that I am HIV positive, there should be no stigma in that. - Rappler.com
Sylvia Estrada-Claudio is a doctor of medicine who also holds a PhD in Psychology. She is Professor of the Department of Women and Development Studies, College of Social Work and Community Development, University of the Philippines. She is also co-founder and Chair of the Board of Likhaan Center for Women's Health.